Provider Demographics
NPI:1306054176
Name:W BRAD GATES MD PA
Entity type:Organization
Organization Name:W BRAD GATES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-801-9100
Mailing Address - Street 1:3108 MIDWAY RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6383
Mailing Address - Country:US
Mailing Address - Phone:972-801-9100
Mailing Address - Fax:972-378-4846
Practice Address - Street 1:3108 MIDWAY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6383
Practice Address - Country:US
Practice Address - Phone:972-801-9100
Practice Address - Fax:972-378-4846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty